Emotion, learning and health

1. Emotion, learning and health Preston Lodge High School 26th October

2. 80 70 60 Life expectancy in years Scotland 50 40 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Year of birth 20th century trends in life expectancy in Scotland and 16 other Western European countries Males

3. Its all about the brain

4. All shapes and sizes!

5. Aaron Antonovsky 1923-1994

7. Sense of coherence.... “.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement."

8. For the creation of health.... ....the social and physical environment must be: • Comprehensible • Manageable • Meaningful

11. STRESS AND GRADE OF EMPLOYMENT: MEN Salivary Cortisol Time of Day Steptoeet al. 2003, Psychosomatic Medicine, 65, 461-470

16. 80 70 60 Life expectancy in years Scotland 50 40 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Year of birth 20th century trends in life expectancy in Scotland and 16 other Western European countries Males

22. Attachment theory “Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.” Crittenden, 2000

23. Attachment theory Ainsworth Deep emotional connection that infant develops with primary caregiver Reflects an “internal working model”expressing the infant’s expectations of parental behaviour in meaningful situations Basis for development of later relationships Increasingly recognised as determinant of later emotional, cognitive and social outcomes

24. “Serve and return” “The ‘instruction’ to attend to the primary caregiver is genetic, the outcome depends on what happens” Balbernie, 2001

25. Disengaged... Who needs to bother about differential calculus? Engaged to respond to danger

26. Environmental determinants of inflammatory status CRP(median) mg/dl affluent deprived

27. hs-CRP and Risk of Future MI in Apparently Healthy Men 3 2 1 0 £0.055 0.056–0.114 0.115–0.210 ³0.211 P Trend <0.001 P<0.001 P<0.001 P=0.03 Relative Risk of MI 1 2 3 4 Quartile of hs-CRP (Range, mg/dL) Ridker. N Engl J Med. 1997;336:973–979.

28. Inflammation in plaques cytokines MMP Lumen Inflammatory Cells Degraded matrix SMC apoptosis Cap Core Inflammatory cells MMPs, IL-6, IL-15, IL-18, CRP Thin Fibrous Cap Unstable

29. CRP and cumulative risk of type 2 diabetes % diabetic Q5: > 4.18 mg/l 5 4 3 2 1 Q1 : <0.66 mg/l 0 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Years in study Freeman et al. Diabetes 2002,51;1596

30. Adipocyte programminginsulin resistance, inflammation and ALP skeletal muscle Insulin resistance triglyceride Atherogenic Lipoprotein Phenotype NEFAs Low HDL small LDL Adipose stores liver IL-6/IL-6sR CRP SAA Pro-inflammatory state TNF-a/ TNF-a sR-I

31. The Stroop Testa test of ‘response inhibition’ Shapes Words Say the names of the colours that the words are printed in Say the colour names of the shapes Say the word names

32. pSoBid: Stroop test p<0.001 Colour-word score Age (years)

33. pSoBid: Verbal Learning p<0.001 Word recall Age (years)

34. The Trails Test:a test of “executive function” Trails “A” Trails “B”

35. pSoBid: Trails B p<0.001 Seconds Age (years)

36. pSoBid: Choice reaction time p<0.001 milliseconds Age (years)

37. pSoBid: psychological state All p<0.001 GHQ = General Health Questionnaire; SoC = Sense of Coherence; RSE = Rosenberg Self-Esteem Scale; BHS = Beck Hopelessness Scale; GSE = Generalised Self-Efficacy Scale

38. The Dunedin cohort 1000 children recruited in late 1972/3 At age 3, “at risk” children identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentiveness As adults, those “at risk” were more likely to : be unemployed have criminal convictions (especially for violence) been pregnant as a teenager have a substance abuse problem exhibit signs of insulin resistance and metabolic syndrome

39. Opportunity to escape poverty, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours

40. Opportunity to escape poverty, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours Meaningful Manageable Comprehensible

41. How many new neurons? >9,000 per day – 250,000 per month in the young adult rat (Cameron & McKay, 2001)

42. Adult neurogenesis in the hippocampus ?

43. 80 70 60 Life expectancy in years Scotland 50 40 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Year of birth 20th century trends in life expectancy in Scotland and 16 other Western European countries Males

45. Fit or fat?